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Acute Kidney Injury - Diagnosis and Management
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Acute renal failure (ARF) usually develops as a complication of another disease process that causes decreased renal perfusion (colic, colitis, hemorrhage, or exhaustive exercise). Recently, there have also been reports of ARF developing with leptospirosis in equids. Treatment with nephrotoxic medications including aminogly-coside antibiotics, oxytetracycline (when administered for correction of flexural deformities in neonatal foals), and nonsteroidal anti-inflammatory drugs (NSAIDs) is an important risk factor for ARF in horses. Other nephrotoxins that can cause ARF include endogenous pigments (myoglobin or hemoglobin), vitamin D or vitamin K3, heavy metals (mercury, cadmium, zinc, arsenic and lead), and acorns. Change in terminology: The term “prerenal failure” has long been used to describe reversible increases in blood urea nitrogen (BUN) and creatinine (Cr) concentrations, also termed prerenal azotemia, associated with compromised renal function. Although use of this term is firmly entrenched in both the human and veterinary medical literature, its use likely contributes to a lack of recognition of subclinical renal damage that accompanies a number of medical and surgical conditions. This can be attributed to a large renal functional reserve capacity. In many patients with reversible azotemia, changes in glomerular and tubular function and integrity can be demonstrated by pigmenturia, proteinuria, cast formation, or impaired concentrating ability (urine specific gravity of 1.015-1.030 in a markedly dehydrated patient), and an increase in urine sodium concentration (>20 mmol/L). Despite the reversible nature of these functional alterations, a degree of nephron loss may occur with prerenal failure. To increase awareness of subclinical renal damage in patients with decreased RBF and GFR, the term acute kidney injury (AKI) has been introduced in human and, subsequently, small animal medicine. AKI is defined as an increase in Cr of 0.3 mg/dL or a 50% increase from the baseline value, yet Cr may remain within the reference range. Hemodynamically-induced AKI is often associated with oliguria (urine output < 0.5 ml/kg for 6 hours) while urine production with nephrotoxin-associated AKI often remains normal (nonoliguric AKI). […]
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Affiliation of the authors at the time of publication
Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, USA.
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